Leadership, Leading, and Influencing Change in Cancer Education: Development and Assessment of a Pilot Leadership Workshop in Cancer Education for Interdisciplinary Healthcare Staff.

Effective leaders in healthcare settings create a motivating work environment, initiate changes in practice, and facilitate interdisciplinary collaboration to advance patient-centered care. Health professionals in cancer education need leadership development to meet the continued rise in cancer cases and to keep up with the rapid biomedical and technological advances in global cancer care. In addition, leadership development in cancer education supports interprofessional collaboration, optimizes patient engagement, and provides mentorship opportunities necessary for career advancement and skill development. The identified benefits from leadership development in cancer education led to the creation of an interactive pilot leadership workshop titled "Essential Skills in Cancer Education: Leadership, Leading, and Influencing Change in Cancer Education," held at the International Cancer Education Conference in October 2020. The workshop was led by global leaders in cancer education and utilized lectures, mentorship opportunities, interactive case studies, and individual learning projects to develop leadership skills in multidisciplinary oncology professionals. Fifteen attendees from diverse educational backgrounds and levels of experience participated in the virtual leadership workshop and mentorship program. Following the workshop, participants reported an increase in knowledge regarding how to use different leadership styles, initiate changes in practice, and apply leadership skills in their career development and at their institutions. The feedback received from participants through post-workshop evaluations was overall positive and demonstrated an interest for more leadership development opportunities in cancer education. This pilot workshop shows that leadership is a valuable and teachable skill that will benefit both healthcare professionals and patients in the field of cancer education.

Entrepreneurship, Corporate Social Responsibilities, and Innovation Impact on Banks' Financial Performance.

The basic aim of this research was to check the impact of innovation, corporate social responsibilities (CSR), and entrepreneurship on the monetary performance of banks in five different countries: Qatar, Pakistan, China, the United States (US), and France. This research was conducted to measure the relationship of these factors and innovative workforce activities. The secondary data were collected from websites of twenty five banks in different countries, including Islamic and conventional banks. Different econometric analyses, such as descriptive statistical analysis, correlation coefficient test for measuring the interaction, and ordinary least square regression analysis for determining the impact of dependent and independent variables, were carried out. In the present study, entrepreneurship, CSR, and innovation were taken as independent variables. Board size, frequency of assemblies, and self-employed with large shareholders were included as sub-parts of entrepreneurship. On the other hand, the financial performance of banks was taken as the dependent variable. Return on assets (ROA) and return on equity (ROE) were considered parts of economic performance. The overall conclusions drawn in this study showed that there was a significant relationship between all the studied variables. The research provided useful insights into the long-debated question regarding the relevance of entrepreneurship and CSR.

Battling for Consumer's Positive Purchase Intention: A Comparative Study Between Two Psychological Techniques to Achieve Success and Sustainability for Digital Entrepreneurships.

This research focuses on students' online purchase intentions in Pakistan toward different products available for sale on numerous e-business websites. This study's main objective is to determine which methodology is better to enhance customer online purchase intention. It also aims to discover how to improve perceived benefits and lower perceived risks associated with any available online product and entrepreneurship. AMOS 24 has been used to deal with the mediation in study design with bootstrap methodology. The study was conducted on 250 students from different educational institutes in Pakistan using a simple random sampling technique. A finding of this study suggests that both methods positively impact online purchase intention of consumers and sustainable digital economy. But social media advertisement is more effective through enhancing the perceived benefits of products. In contrast, product content factors are more effective at lowering the perceived risks associated with available online products.

Assessment of occupational noise-related hearing impairment among dental health personnel.

OBJECTIVES: The purpose of the study was to examine hearing thresholds among dental personnel. The secondary aim was to evaluate sound levels among dental equipment that dental personnel are exposed to. METHODS: Two hundred forty-four dentists, dental technicians, dental assistants, and dental students participated. Sixty-two participated as a control group. Audiological thresholds for the test groups were compared to the control group. All participants were from Jordan University Hospital. Participants completed a questionnaire in addition to their audiometric testing. Otoscopy, tympanometry, and pure tone audiometry were included in their assessment. Three-factor ANOVA and t tests were utilized to assess the statistical differences of hearing thresholds among the groups and between the two ears. Pearson correlation test was used to assess the effect of age, experience, and duration of exposure on the degree of hearing loss in the test groups for both ears. RESULTS: The authors reported statistically significant differences among hearing thresholds between the control group and others. Left hearing thresholds were noted to be significantly poorer in the left versus right ear at 1000, 2000, 4000, and 8000 Hz in dental assistants. The authors also reported a significant relationship between the degree of hearing impairment among dental assistants and the daily duration of exposure to dental occupational noise, followed by age. CONCLUSION: Hearing impairment was higher among dental professionals than the control group and especially among dental assistants and technicians. The authors recommended screening guidelines and adapting hearing protection methods for dental professionals and particularly for dental assistants and technicians.

Introducing FDG PET/CT-guided chemoradiotherapy for stage III NSCLC in low- and middle-income countries: preliminary results from the IAEA PERTAIN trial.

PURPOSE: Patients with stage III non-small-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT) in low- and middle-income countries (LMIC) continue to have a poor prognosis. It is known that FDG PET/CT improves staging, treatment selection and target volume delineation (TVD), and although its use has grown rapidly, it is still not widely available in LMIC. CRT is often used as sequential treatment, but is known to be more effective when given concurrently. The aim of the PERTAIN study was to assess the impact of introducing FDG PET/CT-guided concurrent CRT, supported by training and quality control (QC), on the overall survival (OS) and progression-free survival (PFS) of patients with stage III NSCLC. METHODS: The study included patients with stage III NSCLC from nine medical centres in seven countries. A retrospective cohort was managed according to local practices between January 2010 and July 2014, which involved only optional diagnostic FDG PET/CT for staging (not for TVD), followed by sequential or concurrent CRT. A prospective cohort between August 2015 and October 2018 was treated according to the study protocol including FDG PET/CT in treatment position for staging and multimodal TVD followed by concurrent CRT by specialists trained in protocol-specific TVD and with TVD QC. Kaplan-Meier analysis was used to assess OS and PFS in the retrospective and prospective cohorts. RESULTS: Guidelines for FDG PET/CT image acquisition and TVD were developed and published. All specialists involved in the PERTAIN study received training between June 2014 and May 2016. The PET/CT scanners used received EARL accreditation. In November 2018 a planned interim analysis was performed including 230 patients in the retrospective cohort with a median follow-up of 14 months and 128 patients in the prospective cohort, of whom 69 had a follow-up of at least 1 year. Using the Kaplan-Meier method, OS was significantly longer in the prospective cohort than in the retrospective cohort (23 vs. 14 months, p = 0.012). In addition, median PFS was significantly longer in the prospective cohort than in the retrospective cohort (17 vs. 11 months, p = 0.012). CONCLUSION: In the PERTAIN study, the preliminary results indicate that introducing FDG PET/CT-guided concurrent CRT for patients with stage III NSCLC in LMIC resulted in a significant improvement in OS and PFS. The final study results based on complete data are expected in 2020.

The development of the University of Jordan word recognition test.

OBJECTIVE: To develop and validate a digitally recorded speech test battery to assess speech perception in Jordanian Arabic-speaking adults. DESIGN: Selected stimuli were digitally recorded and were divided into four lists of 25 words each. Speech audiometry was completed for all listeners. Participants were divided into two equal groups of 30 listeners each with equal male to female ratio. The first group of participants completed speech reception thresholds (SRTs) and word recognition testing on each of the four lists using a fixed intensity. The second group of listeners was tested on each of the four lists at different intensity levels in order to obtain the performance-intensity function. STUDY SAMPLE: Sixty normal-hearing listeners in the age range of 19-25 years. All participants were native speakers of Jordanian Arabic. RESULTS: Results revealed that there were no significant differences between SRTs and pure tone average. Additionally, there were no differences across lists at multiple intensity levels. CONCLUSIONS: In general, the current study was successful in producing recorded speech materials for Jordanian Arabic population. This suggests that the speech stimuli generated by this study are suitable for measuring speech recognition in Jordanian Arabic-speaking listeners.

Stage I seminoma: Treatment outcomes in a low-income country.

OBJECTIVE: The aim of this report is to address treatment outcomes of patients with early-stage seminoma in a developing country with special reference to patients with history of surgical violation of the scrotum and the potential predictors of disease relapse. PATIENTS AND METHODS: Seventy four patients with pure seminoma were treated at King Hussein Cancer Center (Amman, Jordan) between 2003 and 2010. All patients underwent orchiectomy. All but 3 patients received adjuvant radiotherapy. Patients who underwent surgical violation of the scrotum prior to referral were managed by further excision or irradiation of the scrotal scar. The follow-up ranged from 1 to 200 months (mean, 33 months). RESULTS: At the time of follow-up; all but one patient remain alive. The 3-year relapse-free survival for the entire cohort was 95.9%. Three patients were burdened by relapse, all of whom received adjuvant irradiation following inguinal orchiectomy and initially harbored tumors larger than 4cm upon pathological examination. Median time to relapse was 14 months (range, 8-25 months). None were associated with elevated tumor markers prior to detection of relapse. All but one patient were successfully salvaged by chemotherapy. CONCLUSIONS: Our results confirm the excellent prognosis for patients with early-stage seminoma treated by orchiectomy and adjuvant radiotherapy in a developing country. Although all patients burdened by relapse demonstrated adverse pathological findings upon initial assessment, no consistent predictor of relapse was found. Scrotal scar re-excision or irradiation in patients with prior history of surgical violation of the scrotum is effective in preventing local failure. KEYWORDS: Seminoma, stage I, radiotherapy, scrotal violation, developing country, management.

Choroidal metastases as the sole initial presentation of metastatic lung cancer: case report and review of literature.

BACKGROUND: Choroidal metastasis as an initial presenting feature of metastatic lung cancer is exceedingly rare. External beam radiotherapy (EBRT) is an effective and widely accepted therapeutic modality. However, data addressing the effectiveness of other treatment strategies is limited. Herein, we present a patient with choroidal metastases secondary to lung cancer and review the relevant literature. CASE REPORT: A 25-year-old male presented with deterioration of vision. His evaluation revealed bilateral choroidal metastasis secondary to adenocarcinoma of the lung. Unfortunately, his vision continued to deteriorate despite treatment with EBRT and chemotherapy. CONCLUSION: Metastatic lung cancer can manifest with choroidal metastasis as an initial presentation.

Choroidal metastasis as the sole initial presentation of metastatic lung cancer.

Choroidal metastasis as an initial presenting feature of metastatic lung cancer is exceedingly rare. External beam radiotherapy (EBRT) is an effective and widely accepted therapeutic modality. However, data addressing the effectiveness of other treatment strategies is limited. We present a patient with choroidal metastases secondary to lung cancer and review the relevant literature. A 25-year-old male presented with deterioration of vision. His evaluation revealed bilateral choroidal metastasis secondary to adeno- carcinoma of the lung. Unfortunately, his vision continued to deteriorate despite treatment with EBRT and chemotherapy. Choroidal metastasis as an initial presentation of metastatic lung cancer is exceedingly rare, as only 30 cases have been reported. EBRT and systemic chemotherapy are effective therapeutic modalities. This case report could prove helpful to clinicians faced with a similar exceedingly rare scenario.

Eight primary malignancies: case report and review of literature.

The incidence of multiple primary malignancies has increased over the past years secondary to the long-term survival of cancer patients due to improvements in the early detection and adequate treatment of cancer. We present a patient with eight primary malignant tumors and review the relevant literature. Our patient was a 59-year-old female with Crohn disease with an otherwise non-contributory medical history. Risk factors for multiple primary tumors were not detected in our patient. At a follow-up of 108 months from the time of diagnosis of the first malignancy, our patient was still alive. Similar long-term survival has been reported in the literature. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients.

Orbital emphysema after a protracted episode of sneezing in a patient with no history of trauma or sinus surgery.

Orbital emphysema is a benign self-limiting condition. It can occur directly (as a result of trauma to the face) or indirectly (secondary to a blowout fracture). We report a case of orbital emphysema in a 38-year-old man who presented with ecchymosis of the right eye, pressure within the right orbit, and periorbital swelling following a protracted episode of vigorous sneezing. The diagnosis was confirmed by computed tomography. Systemic antibiotics were given, and the patient was cautioned to avoid blowing his nose. His signs and symptoms resolved within 1 week.

Evaluation of dizziness at Jordan University Hospital.

OBJECTIVE: This study was performed prospectively to evaluate the dizzy patients in the Neurotology Outpatient clinic at Jordan University Hospital, Amman, Jordan during the period 1993-2000 and to discuss the prevalence and etiology of dizziness. METHODS: Data were collected from 108 patients (52 males and 56 females) with a mean age of 45.6-years. Diagnosis was made on the basis of history, physical, otolaryngological and neurological examination and confirmed by relevant investigation including laboratory, radiological and audio vestibular tests. RESULTS: Secure diagnosis were made in 98% of patients (14% had one cause alone and 84% had multiple causes). Cardiovascular disorders accounted for 31.5% of primary and 49% of secondary causes, peripheral vestibular disorders, 25% of primary and 3% of secondary causes, central vestibular disorders 17% of primary and 9% of secondary causes, metabolic endocrine 13% of primary and 38% of secondary causes, cervical osteoarthritis 5.5% of primary and 28% of secondary causes and psychogenic 4.6% of primary and 6.5% of secondary causes. CONCLUSION: Our findings demonstrate that vertigo is the most common subtype of dizziness (50%). Multiple causes are more prevalent in older age and the single cause is more prevalent in younger age. Cardiovascular was the most common cause of dizziness followed by vestibular disorders, metabolic and cervical osteoarthritis. Vestibular disorders are primary causes and non vestibular are predominantly secondary causes of dizziness. Hyperlipidemia, diabetes and cervical causes are major secondary contributors to dizziness. We recommend a multi disciplinary setting and application of a comprehensive diagnostic and treatment approach without unnecessary protracted investigative scheme and installment of rehabilitation facilities.

Objective high-frequency tinnitus of middle-ear myoclonus.

Tinnitus produced by middle-ear myoclonus is a rare condition. In this article, a rare case of unilateral continuous high-frequency objective tinnitus caused by middle-ear myoclonus is described. This condition appears to be the second case reported in the literature. Otoscopic examination revealed visible rhythmic movements of the tympanic membrane. Weak clicking sounds were heard around the right ear by auscultation. Direct stimulation of the soft palate showed no evidence of palated myoclonus. Tympanometry confirmed rhythmic changes in the middle-ear compliance. The condition was effectively treated with a muscle relaxant (orphenadrine citrate).

Cauterization of inferior nasal turbinate for idiopathic headache.

OBJECTIVE: Idiopathic headache is a stressful complaint, whose treatment is not well established. Our study is an attempt to examine the relationship between idiopathic headache and inferior turbinate cauterization as a surgical treatment, and to explain the central physiological effect of cauterization. METHODS: Thirty-four patients, 15 females and 19 males complaining of idiopathic headache were treated by inferior turbinate cauterization. Cauterization of the inferior-medial aspect of the turbinate was carried out once under local anesthesia for few seconds. This study was performed between November 1993 and December 1996, a joint project of the Zarka Government Hospital, Zarka and Faculty of Medicine, University of Jordan, Amman, Jordan. RESULTS: More than 82% of the patients showed significant improvement in the sense of decreased headache. CONCLUSION: Cautery of the nasal turbinate could be a novel method for treatment of idiopathic headache.

Cauterization of inferior nasal turbinate for idiopathic headache.

OBJECTIVE: Idiopathic headache is a stressful complaint, whose treatment is not well established. Our study is an attempt to examine the relationship between idiopathic headache and inferior turbinate cauterization as a surgical treatment, and to explain the central physiological effect of cauterization. METHODS: Thirty-four patients, 15 females and 19 males complaining of idiopathic headache were treated by inferior turbinate cauterization. Cauterization of the inferior-medial aspect of the turbinate was carried out once under local anesthesia for few seconds. This study was performed between November 1993 and December 1996, a joint project of the Zarka Government Hospital, Zarka and Faculty of Medicine, University of Jordan, Amman, Jordan. RESULTS: More than 82% of the patients showed significant improvement in the sense of decreased headache. CONCLUSION: Cautery of the nasal turbinate could be a novel method for treatment of idiopathic headache.

Effectiveness of treatment of tonsillopharyngitis: comparative study.

This study was performed to find out the effectiveness of three different treatments of patients having acute tonsillopharyngitis. Three groups of patients were selected (50 patients in each group). Group I received one antibiotic according to the result of culture and sensitivity test, while groups II and III received two antibiotics or one antibiotic respectively without a culture and sensitivity test. Diagnosis was based on the acutely subjective symptoms of sore throat and positive clinical examination findings. The effectiveness of treatment in group I (96 per cent) was statistically significant (p<0.05) and higher than group II (82 per cent) and group III (74 per cent), while the difference between group II and III was not statistically significant (p>0.05). Our findings demonstrate that a culture and sensitivity test of the throat swab is necessary before treating acute tonsillopharyngitis. It was suggested that there should be appropriate selection of antibiotics to preserve normal flora, avoidance antibiotics for viral infections, patient compliance with prescription and educational programmes directed at patients and physicians. All of these measures would assist in reducing the volume of antibiotic use, bacterial resistance and the overall cost of treatment of tonsillopharyngitis.

Leptomeningeal carcinomatosis from carcinoma of the palatine tonsil.

Distant metastases from carcinoma of the palatine tonsil are very uncommon. We encountered a case of a carcinoma involving the tonsillar region that resulted in subarachnoid mestastases following local radical radiotherapy. Metastases were diagnosed following magnetic resonance imaging and spinal fluid cytology. The patient succumbed to the disease after a rapid downhill course, 1 month following diagnosis of the secondary deposit. The present paper describes the rare site of distant metastasis and reviews the relevant literature.